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Skilled nursing vs. hospital

Posted January 22, 2014 in Advice Column

As a nursing home administrator, I understand the ins and outs of skilled nursing and therapy. After my elderly mother underwent shoulder replacement surgery recently, she needed skilled nursing services to get back on her feet. Although I wanted a specific plan of treatment for her,  I chose to honor her and allow her to make her own decisions about her health.  She opted to receive skilled nursing at her local hospital.

After a couple weeks of skilled nursing, the hospital therapists said she was ready for discharge. She had reached the goals they set for her.  Upon her release, it was decided that she could return to my brother’s home to stay and receive home health services three times a week.

We quickly realized this was not working. She could not dress herself, stumbled and was very unsteady. Add toileting troubles and an inability to wear the type of clothing she was accustomed to, and we had an issue. To me this wasn’t only a problem with dignity but also kept us from creating an atmosphere conducive to healing. She wasn’t ill but needed to recover. A big part of that was getting dressed daily in normal clothing.

Another misstep in the healing process was her isolation. She was not allowed to go out for coffee or visit friends because of needing to be homebound in order to receive home health services.

All this left my mother very frustrated and feeling like she was not getting better. In fact, she felt like she was losing ground. So, we discussed her options again and she chose to go to her local nursing home.

My mother spent three weeks at this facility, receiving daily therapy on gait training, how to dress herself and pull up her pants with one arm. Most importantly, she was with other people and didn’t feel so lonely. I’m happy to report that she returned home Christmas Eve and is doing very well. She continues to receive some home services and therapy, but the progress is much better.

The moral of the story: We did everything backwards. If we had started with skilled services first, she could have been much further along. See, the nursing home didn’t just treat her shoulder, but rather the whole person.  Nursing homes are mandated to look at the whole person, not just a diagnosis or ailment. Hospitals are specific — treat the diagnosis because that is how they get paid.

If I could do it all over again, I would have taken my own advice and been more persuasive about her going to the nursing home.  I am convinced she would have been home sooner and more successful once she was home.

Information provided Diane Hill, administrator, The Continental Care Center at Seymour, 400 East Fourth St., Seymour, 641-898-2294.

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